[Refractory hypotension sustained during general anesthesia due to chronic treatment with angiotensin-converting...

Perioperative management of angiotensin-converting enzyme inhibitors (ACEI) is controversial because of associated hypertensive episodes during induction and maintenance of anesthesia. A 71-year-old woman with a non-functioning thyroid node was scheduled for thyroid lobectomy. Her medical history included high blood pressure and she was being chronically treated with ACEI, which were taken until the morning of surgery. After induction of anesthesia, arterial hypotension refractory to crystalloid therapy developed and worsened in spite of administration of a gelatin-type colloid (Gelafundina). The patient did not respond to ephedrine or dopamine and required stabilization with adrenalin in continuous perfusion for 12 hours. Later evolution was satisfactory and recovery took place without sequelae. We discuss the anesthetic implications of chronic ACEI treatment and possible hemodynamic repercussions of associated administration with gelatin-type solutions or human albumin.